Availity's Authorizations & Referrals tool (HIPAA-standard 278 transaction) allows providers to electronically submit prior authorization requests for inpatient admissions, select outpatient services and referral requests managed by BCBSTX Medical Management. Additionally, Providers can also check status on previously submitted requests and/or update applicable existing requests.
Benefits of using this online functionality:
- No separate user enrollment needed
- Direct access within Availity Essentials
- Simplified 4-step process
How to access and use Availity Authorizations & Referrals:
- Log in to Availity
- Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations*
- Select Payer BCBSTX, then choose your organization
- Select a Request Type and start request
- Review and submit your request
*Choose Referrals instead of Authorizations if you are submitting a referral request.
For additional details, refer to the Authorizations User Guide and Referrals User Guide.
Important Tips:
- Check eligibility and benefits online first to determine if prior authorization is required for the service and/or procedure code(s). Learn more on using Availity for Eligibility and Benefits.
- Authorizations managed by Carelon Medical Benefits Management are handled through the Carelon ProviderPortal.
- Authorizations managed through EviCore® by Evernorth are handled through the eviCore portal.
- For Recommended Clinical Review requests:
- Submit via Availity Attachments tool by completing and uploading the appropriate form. Learn how to submit electronically by referring to the Availity Attachments: Submit Recommended Clinical Review Requests.
- You can also use BlueApprovR via single sign-on access from Availity to submit recommended clinical review requests for some inpatient and/or outpatient, medical and surgical and specialty pharmacy drugs for many BCBSTX commercial members.
- If you do not have Availity access, you may fax or mail the appropriate form in the Forms section.
Providers who are not yet registered with Availity, can sign up today at Availity, at no charge. If you need registration assistance, contact Availity Client Services at 1-800-282-4548.
Questions?
Email our Provider Education Consultants. Be sure to include your name, direct contact information, Tax ID and/or Billing NPI.
Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member's ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is wholly responsible for its own products and services.
Carelon Medical Benefits Management is an independent medical management company that has contracted with BCBSTX to provide utilization management services for members with coverage through BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors and the products and services they offer.